Partnership ensures SAFE access for victims

With a motto that says, "Because we Care" it is no small coincidence that when Ireland Army Health Clinic transitioned from a hospital to its current status in 2016, it took a long look at all the people it served to make sure it was giving them the care they deserved.

As a result, IRAHC signed an agreement with Hardin Memorial Hospital, late last year, to ensure patients who need support after a sexual assault would receive the best care.

"I am very proud of the work we have done, in coordination with our community partners, to ensure victims of sexual assault receive the high standard of care previously provided at IRACH," said Lt. Col. Rebecca Terry, the deputy commander at IRAHC. "Our patients can be confident that the right care is available if they need it."

The change in Ireland's status meant they no longer have 24-hour coverage, no longer have an emergency room with the proper staff, or the ability to perform sexual assault forensic examinations. With those changes in mind the IRAHC command group put together a plan that would mean continued quality care.

According to Sarah Tovar, an RN and a sexual assault nurse examiner at HMH, when a victim comes to the HMH hospital it doesn't matter who it is--her team provides care from arrival to discharge.

"We triage them, provide a sexual assault exam and any medical treatment they might need," she explained. "There are two responders/advocates--one from the military side and one from the civilian side--who the patient can talk to. The patient decides who they want to work with, and what/if they want to do. The advocates are there to work together to benefit the patient."

She added that the Sexual Assault Nurse Examiner program was modeled after a nationally recognized program.

"We provide a sexual assault nurse examiner who is an RN," she said. "They undergo 100 hours of specialized training in class (40 percent) and clinical (60 percent), to get certificate, and then apply for license."

In the immediate future, and with the remodel of the HMH emergency room, a dedicated, private room located in the ER will be available to victims of sexual assault. Tovar said when a victim comes to the ER and makes a report they will be immediately expedited to the designated SAFE room. It is designed for privacy with a solid door so no one can be identified, a private bathroom to include a shower and the head of the bed faces away from the door.

Anesha Knott, an RN, a sexual assault medical forensic examiner at IRAHC, and the Fort Knox sexual assault care coordinator, said just because the forensic testing is done at HMH doesn't mean military personnel should think Fort Knox is out of the picture.

"The patient is later transferred back to post for medical, and if needed, psychological care," she explained. "There are two types of reporting in the military system that are similar to the civilian, but have a difference. In the military there is restricted and unrestricted. But on the civilian side there is 'reported' and 'unreported.' The patients we see can decide which system they want to use--they aren't required to use the military system."

In a restricted report a victim can receive medical care and have a sexual assault forensic exams completed along with behavioral health care if requested. A law enforcement investigation is not opened as long as the assault is only reported to the sexual assault response coordinator, victim advocate, or health care provider. SAFE kits are kept at the Provost Marshall's office for 5 years which gives the victim time to change their mind after evidence is collected if they choose to change their report to unrestricted.

In an unrestricted report, the victim receives all of the above care but also reports the event to law enforcement.

In the civilian side everything is the same except that the kits are only kept for one year so the victim only has one year to decide to report the case.

Capt. Zane Dye is a sexual assault medical forensic examiner and a victim advocate. He said while it isn't unusual for a man to be a SAMFE, they aren't everywhere but are more welcome than the stereotype suggests.

"In my experience women are as comfortable and sometimes more, because they feel less judged by their peers so it helps to open up easier," he said. "And research has shown that if they can have a positive interaction with a male after a sexual assault their risk of PTSD goes down. I've never had a female decline to work with me, and several specifically request to work with a man."

He added that DoD is actually "leading the way" when it comes to sexual assault response and prevention. He said the military has similar demographics as college campuses, but it has more data.

"For example, how assaults are occurring, who is at risk, the percentage of people who are seeking treatment and how affective it is, and the legal outcomes. But some higher education facilities are not yet at this level."

And to stay ahead of the game, he said the Army offers SAFE nurses of both genders to provide the best care possible by helping build rapport with the victim.

"A good rapport can help the patient to feel comfortable reliving the event, and helps guide medical and law enforcement professionals to secure the best possible outcome for the patient," he explained.

And that isn't just concern for female victims. Dye said that in 2014 alone, according to DoDs fiscal year 2014 annual report of sexual assault in the military, there were more than 1,500 male victims. He added these victims traditionally suffer lower reporting rates because of the stereotype that goes along with being a male who has been assaulted.

The risk factors he often sees repeated are: the victim is typically a younger soldier who is living in the barracks, doesn't have a support group, alcohol is involved and since they want to fit in, they might drink too much.

"I feel as though more men in forensic nursing could help male patients come forward. I have personally given line units SHARP briefings so they know where to go for services and what to do. And so they are aware of services available to them and that they will be treated with dignity and respect."
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INFO BOX:
FACTS:
*A victim can always change a restricted/non reported to an unrestricted or reported case. Once a case is unrestricted/reported it cannot be changed back to restricted/non reported.
*If an active duty Soldier reports he/she has been assaulted to his/her battle buddy, or a friend, who is NOT in their chain of command, that Soldier can help get them to a SARC--or just be there for them, but the event can remain restricted.
*If a victim arrives at HMH for a SAFE exam and does not have a victim advocate with them HMH will call the SHARP hotline to request a VA.